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Cardiovascular > Arrhythmia 1 > Flashcards

Arrhythmia 1 Flashcards

1
Q

What does supraventricular mean and include?

A

Non-specific term as it means origin is above the ventricle

ie. AV node, SA node, atrial muscle. Slide 4

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2
Q

What are the possible supraventricular arrhythmias?

A 
Atrial Fibrillation
Atrial Flutter
Ectopic Atrial Tachycardia
Sinus bradycardia
Sinus pauses. 
Slide 5
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3
Q

What are the possible ventricular arrhythmias?

A 
Ventricular ectopics or premature ventricular complexes (PVC)
Ventricular tachycardia
Ventricular Fibrillation
Asystole.
Slide 6
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4
Q

What are possible arrhythmias that could arise in the AV node?

A

AVN re-entry tachycardia
AV reciprocating tachycardia
AV block from 1st to 3rd degree. Slide 7

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5
Q

What are the anatomical and autonomic nervous system causes for arrhythmias?

A

Anatomy:
LV hypertrophy
Accessory pathways
Congenital HD

Nervous:
Sympathetic stimulation e.g. stress
Increased vagal tone. Slide 9

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6
Q

Apart from anatomical and nervous causes, what else could cause arrhythmias?

A 
Metabolic e.g. hypoxia
Inflammation e.g. myocarditis
Drugs
Genetics e.g long QT syndrome
Slide 9
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7
Q

What are the electrophysiological mechanisms of an arrhythmia?

A

Ectopic beats:
Altered automaticity
Triggered Activity

Re-entry:
Accessory pathway tachycardia.
Slide 10

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8
Q

What are the 4 ways to alter automaticity?

A

Change the slope to threshold
Change the threshold itself
Change resting memebrane potential
PNS can afftect phase 4 slope. Slide 13

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9
Q

Why does hypokalaemia cause an increase in heart rate?

A

Due to the increase in phase 4 slope and prolongs repolarisation. Slide 14

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10
Q

What is triggered activity and what are the potential causes?

A

In phase 3 a small depolarisation may occur whcih if sufficient then may triger a sustained train of depolarisations which is triggered activity.
Digoxin toxicity
Long QT syndrome and hypokalaemia
Slide 15

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11
Q

How does Re-entry of a potential cause an arrhythmia and what are some structural causes of re-entry?

A

There is a second conduction pathway and causes another potential to split off from the main potential and become a recurrent potential circling back to the atrium.
Structural: Accessory pathways, scars from previous MI and congenital HD. Slide 17+21

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12
Q

What are the symptoms of an arrhythmia?

A 
Palpitations
SOB
Dizziness
Syncope
Faintness
Sudden cardiac death
Angina
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13
Q

What are the investigations of arrhythmias?

A 
12 lead ECG
CXR
Echocardiogram
Stress ECG for exercise related arrhythmias
24hr ECG
Slide 26
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14
Q

On an ECG what indicates pre-excitation?

A

The slope up to the QRS called a delta wave and a short PR interval. Slide 28+44

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15
Q

Sinus arrhythmia is bad. True or False?

A

False, sinus arrhythmia is the only normal arrythmia where during inspiration and expiration the heart can speed up or slow down. Slide 35

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16
Q

What is the treatment for sinus bradycardia?

A

Atropine

Slide 36

17
Q

What does orthodromic and antidromic AV reciprocating tachycardia present as on a ECG?

A

Orthodomic AVRT:
Inverted P wave after QRS
Antidromic AVRT:
Wide QRS complex with delta wave. Slide 44

18
Q

What is the acute and chronic management of supraventricular tachycardia management?

A 
Acute:
Slow AV node conduction
-IV adenosine/verapamil
Increase vagal tone:
-Carotid massage
Chronic:
Avoid stimulants
Radiofrequency ablation in young patients
B blockers
Anti-arrhythmic drugs. Slide 46
19
Q

What is radiofrequency catheter ablation?

A

Selective cautery of cardiac tissue to prevent tachycaria. Slide 47

20
Q

What are possible causes of heart block?

A 
Ageing
Acute MI
Myocarditis
Amyloid
Drugs e.g. B blockers, Ca antagonists
Aortic valve disease
Genetic e.g. Lenegre's disease. Slide 51
21
Q

What is 1st degree AV block and what is the treatment?

A

When the conduction from P wave to QRS is longer.

There is no treatment just monitor incase it gets worse. Slide 52

22
Q

What are the two types of 2nd degree AV block?

A

Mobitz I: progressive lengthening of the PR interval and results in a dropped beat.
Mobitz II: Pathological and is usually in a 2:1 P wave to QRS.
Slide 53

23
Q

What is 3rd degree heart block?

A

When there is no action potential from the SA node.

Instead there is only rhythm coming spontaneously from the ventricular myocytes. Slide 57

24
Q

If the QRS complex is narrow it is ____, if the QRS complex is broad it is ____.

A

Atrial - narrow
Ventricular - broad
Slide 57

25
Q

What are the types of pacemakers?

A

Single chamber or dual chamber. Slide 59

26
Q

What are the possible causes for ventricular ectopic beats?

A

Structural: LVH, myocarditis
Metabolic: Ischaemic heart disease
Slide 61

27
Q

If there is a man who is acute SOB at rest and chest pain
70 male, hypertension, diabetes, Smoker.
Had a remote MI six months ago.
What is the most common diagnosis?

A

Ventricular tachycardia until proven otherwise. Slide 63

28
Q

What is ventricular tachycardia?

A

When patients have significant heart disease and is life threatening but is harmodynamically stable. Slide 64

29
Q

Why do some patients feel light headed or syncope due to ventricular tachycardia?

A

As there is a large sustained reduction of arterial pressure. Slide 65

30
Q

What are the differences between monomorphic VT and polymorphic and what does polymorphic VT have monomorphic doesn’t?

A

Monomorphic is haemodynamically stable as the VT rhythm is regular
Polymorphic is haemodynamically unstable and has an irregular VT rhythm.
Polymorphic has signs of torsades de pointes.
Slide 66+67

31
Q

What is Ventricular fibrillation?

A

Chaotic ventricular electrical activity which causes the heart ot lose the ability to function as a pump. Slide 68

32
Q

What is the acute and long term treatment of VT?

A

Acute
Unstable: Direct current cardioversion
Stable: Pharmacologic cardioversion.

Chronic
Correct ischaemia
Anti-arryhtmic drugs
Implantable cardiovertor defibs.
VT catheter ablation.
Slide 69+70
33
Q

What does an ICD do?

A

Termination the occurance of a VT or VF by defibirillation. Slide 72

Cardiovascular (47 decks)

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